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Individual

MR. JEREMY R HOLMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
2200 E PARRISH AVE, BLDG D SUITE 100, OWENSBORO, KY 42303-1449
(270) 688-1770
Mailing address
2200 E PARRISH AVE, BLDG D SUITE 100, OWENSBORO, KY 42303-1449
(270) 316-9795

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
99027503A
IN
363A00000X
Physician Assistant
Primary
TC020
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000526456
ANTHEM
Enumeration date
06/20/2007
Last updated
07/08/2013
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